Adult Internal Medicine Sub-Internship

Department of Medicine and Medical Specialties

  • Course Information

    Course Number: RMDN680

    Prerequisites: Completion of all Phase 2 clerkships

    Length of Time: 4 weeks

    Phase Availability: Phase 3

    Credit Type: Physician Assessed Patient Facing (PAPFE), Sub-Internship (Sub-I), or Open

    Call: Every 4th night

  • Contact Information

    Program Director at OSF St. Anthony Medical Center: Charles Welford, MD

    Program Directors at Mercyhealth Javon Bea Hospital: Thomas Brefeld, MD; Jon Monkemeyer, MD

    Coordinator/Scheduling: Allison King (aking75@uic.edu)

    Locations: OSF St. Anthony Medical Center (5666 E. State St., Rockford, IL), Mercyhealth Javon Bea Hospital (8201 Riverside Blvd., Rockford, IL)

Narrative Description: The overarching goal of this Sub-I is for the student to develop the appropriate skills to be ready for the transition to residency including sharpening skills as future diagnosticians, improving interviewing, exam, note writing, and formulating detailed assessments and plans in an inpatient setting. As such, he/she will work directly with the attending Medicine hospital physicians on a daily basis, learning the skills and responsibilities of a resident physician.

Learning Objectives and Activities:

  1. Time management skills
    1. Organize a daily patient care task list for each patient in a structured and systematic way so that required tasks (e.g., daily notes, orders, etc.) are not overlooked.
    2. Prioritize daily patient care task list according to degree of importance/urgency.
    3. Prioritize patients’ clinical problems according to degree of clinical importance/urgency.
    4. Recognize one’s own limitations and call on other team members to help.
  2. Communicating effectively within healthcare teams
    1. Write accurate, concise, and well-organized consult and progress notes; and where applicable, transfer notes, discharge summaries, and cross-cover notes
    2. Provide an oral presentation of a clinical encounter, tailoring length and content according to context.
    3. Give and receive patient handoffs (both in writing and verbally) to transition care responsibility.
    4. Speak with specialist/subspecialist colleagues to request consultation.
    5. Communicate collaboratively with nursing and pharmacy staff to enhance patient care.
    6. Communicate effectively with team case manager, social worker, and outpatient care to facilitate discharge planning
  3. Patient evaluation skills—recognizing sick vs. non-sick patients
    1. Gather appropriate clinical data from all appropriate sources (e.g., patient, family, nurse, medical records) in hypothesis-driven fashion to address the main clinical problems (Reporter function of RIME)
    2. Analyze and synthesize the collected clinical data set to formulate a prioritized differential diagnosis for the main undifferentiated problems (Interpreter function of RIME)
    3. Recognize which clinical situations require additional assistance from upper level resident, faculty attending, and/or specialty consultants.
    4. Develop initial diagnostic and/or therapeutic management plans for the main clinical problems (Manager function of RIME)
    5. Prioritize problem list according to degree of clinical importance (Interpreter function of RIME).
  4. Knowing when to ask for assistance
    1. Recognize various techniques that can enhance and develop metacognitive skills
    2. Generate clinical questions and retrieve evidence to advance patient care
    3. Identify clinical and contextual situations that require assistance from clinical supervisors
    4. Utilize a communication framework when calling for clinical support

Daily Responsibilities:

  1. Performing a full history and physical on admission, formulating a differential diagnosis, and developing preliminary evaluation and treatment plans for all new patients assigned to them, with review by the attending physician. [the sub intern should admit no more than 2 new patients a day].
  2. Bedside presentation of their patients and written daily SOAP progress notes and orders [the sub intern may provide continuity of care to no more than 5 patients per day].
  3. The student may call for consults consistent with hospital policy.
  4. Review of daily orders with the attending physician.
  5. Night call not currently scheduled
  6. Communicating with their patients and families, nurses, ancillary staff and other providers about the day-to day needs and action plans as reviewed with the attending physician.
  7. Beginning discharge planning, discussing with discharge planners [case managers, social workers] regarding outpatient therapy (OPAT), and assisting in the process of obtaining the resources and referrals needed for a safe discharge.
  8. Generating a discharge summary for their patients which will be reviewed and signed by the responsible attending physician.
  9. Contacting the PCP at discharge re: follow-up plans if requested by the attending.
  10. Participate fully in family meetings, end of life and code discussions, and emergent bedside management of their patients.
  11. Participate in all educational sessions scheduled during the sub-Internship.
  12. Keep a log of patients seen and lessons learned from the patients.

Specific Internal Medicine Responsibilities:

  1. Research and discuss internal medicine topics in detail including a critical appraisal of the medical literature (Students at OSF SAMC will present this information to Dr. Welford, hospitalists and M3 students).
  2. Work in a team with M3 students including supervision, teaching and feedback.
  3. Effectively utilize electronic health record to obtain information and enter orders;
  4. Sharpen assessment and plan skills including performing advanced history and physical exam skills;
  5. Critically evaluate at least one journal article weekly;
  6. Observe and if possible participate in code blue resuscitations in the hospital
  7. OSF SAMC location only: Attend Grand Rounds at St. Anthony Medical Center when in session.

Method of Assessment:

  1. The student will be evaluated by the attending physicians in areas of professionalism, history taking and physical examination skills, differential diagnosis skills, management planning skills, oral and written communication skills, and interpersonal collaboration.
  2. Patient Log will be reviewed by supervising attending;
  3. Standard UIC evaluation form completed and submitted.
  4. Additional evaluation forms for cross-cover notes and discharge summaries may be used for formative evaluation

Required Reading: Students are expected to utilize appropriate sources such as UpToDate, DynaMed, standard medical textbooks, and medical journals in researching and learning about the patients they see.

Additional Resources: Check the Rockford – Phase 3 (Year 4) Canvas for additional Sub-I resources and materials.